A Family Doctor's Tale -ECU tendonitis

DOC I HAVE EXTENSOR CARPI ULNARIS TENDONITIS

EXTENSOR CARPI ULNARIS TENDONITIS OR ECU is the inflammation of the tendon sheath of the tendon to the small finger at wrist region.

EXTENSOR CARPI ULNARIS TENDONITIS occur occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.

When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling.

Women are affected more than men.

Local causes:
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1.trauma of the tendon of the small finger from repetitive weight bearing of the wrist

2.direct injury on the tendon of the wrist from a direct blow to the hand

3.repetitive use of the wrist on keyboard of computer

4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift as a result of overusage of the wrist

5.common among young and active especially those who play racket sports and basketball

Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:

1.swelling and pain of the back of the wrist near the small finger side (opposite De Quarvian's Disease)

2.unable to move wrist  or carry heavy objects

Physical examination
1.tendon nodules in flexor tendon of the small finger at wrist level

2.tenderness on flexion of the wrist

2.diagnosis is confirmed with CAT scan or MRI

Treatment:
1.Rest and splinting of affected finger and wrist

2.wrist exercise usually good.

3.Non-steroidal anti-inflammatory drugs for inflammation and pain

4.Corticosteroid injection to reduce inflammation under the narrowed sheath

5.Surgery as last resort to release the tendon by cutting the top part of the  narrowed inflammed sheath

Complication:
If left untreated. it can lead to the permanent loss of rotation of the wrist

Prognosis :
1.usually good with injection of corticosteroid

2.recurrence may occur after injection in which case surgery should be done

Prevention:
1.Avoid forceful use of the wrist and small finger

2.Avoid repetitive movement of the wrist.